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angina pectoris/MI

antianginal/ anticlotting

Angina pectoris Acute chest pain caused by insufficient oxygen to a portion of the myocardium accompanies physical exertion/emotional excitement duration usually short pain this ministry is with rest or stress reduction
Signs and symptoms of angina pectoris Study intense pain pain radiating to left shoulder, arm, spine, jaw fear of impending death dyspnea, diaphoresis, pallor (pale color) tacky, elevated BP
Types of angina Stable – fairly predictable as to frequency, intensity, duration relieved w rest vasospastic/ prinzmetals-spasms of coronary arteries due to decrease myocardial blood flow silent- absence of chest pain unstable- more frequently intense & during rest
atherosclerosis The buildup of fats and cholesterol and other substance in and on the artery walls
CABG(Coronary artery bypass graft) A portion of a pain from the leg or chest is used to create a bypass artery for severe cases of coronary obstruction
Management of angina Anti-anginal drugs: slows the hrt rate dilate veins so the hrt receives less blood (- preload) causes the hrt to contract with less force (- contractility) lowering BP, the hrt less resistant when ejecting blood from its chambers (-afterload)
Angina versus myocardial infarction Angina is more likely to be completely relieved by nitroglycerin up legal tablets is to decrease blood supply and pain with moving
Diagnostic Tests: angina/ MI Electrocardiogram (ECG) Cardiac enzymes Creatine Kinase (CK) CK-MB Troponin I Troponin T Cardiac Echo
PCI procedure (percutaneous coronary intervention) Coronary arteries significantly obstructed may include atherectomy (removing the plaque) or angioplasty (compressing the plaque against the vessel wall) stents are inserted following angioplasty.
Drug therapy for angina pectoris Nitrates – Drug of choice for term acute episodes of stable Beta blockers – often the drug of choice for prophylaxis of stable CCBs – drug of choice for treating vasospactic labs:Urinary catecholamines, vanillylmandelic acid concentration (VMA)
Nitroglycerin/ Nitrostat Class: Nitrates Relax arterial and venous move muscles dilate coronary arteries by reducing the amount of bld returning to the heart, so the chambers contain a smaller volume and reduces cardiac output.
nitrates Admin: use class IV bottle special IV tubing for IV admin, cover the IV bottle to reduce the integration due to light exposure, use gloves when administering nitroglycerin, Preg Cat C.
Nitrate- adverse/contradictions/interactions pt 1 Side: hypotension dizziness headache was enough face rash tachycardia. Con: do not give with pre-existing hypotension, high intracranial pressure or head trauma, pericardial tamponade and constructive pericarditis cannot increase cardiac output
Nitrate- adverse/contradictions/interactions pt 2 Sustained-release not given to pts w glaucoma ^ intraocular pressure. Inter: Viagra, Levitra, Cialis may cause hypotension and cardiovascular collapse. Use w alcohol and anti-HTN cause hypotension. herbal: Hawthorne result in hypotension
assessments for nitrates Complete health history, vitals, labs subsided or decreased chest pain hrt rt, ECG & bp wnl 1 nitro rep 2 times q 5 min prn remove patch 6-12 hr HS observe neurologic cardiac and respiratory report h/a change in hrt or lung sounds consciousness
Lifespan of angina/MI Use subjective and objective data in evaluating pain really and ethnically diverse in older patients older adults at risk for hypotension history of cardiac or CVA disease recent head injury worsened by vasodilation report abnormal angina BP pulse
Patient teaching for angina/MI Monitor BP and pulse proper use of nitroglycerin and patches cleanse skin and rotate sites use hair-free area no arms or legs do not take ED meds may cause dizziness so change positions slowly report mental status consciousness palps dyspnea cough
Atenolol/ Tenormin Class: beta blocker Reduce the cardiac workload by slowing heart rate and reducing contractility which lower myocardial oxygen demand Action: antianginal admin: BP and pulse before dose, recheck after oral dose, given once daily, Preg Cat D
Atenolol side/warning/con Side: fatigue weakness bradycardia and hypotension warning: abrupt d/c avoided in pts w is she Mick heart disease con: do not give with severe brady aterioventricular heart block cardiogenic shock decompensated HF and severe hypotension
atenolol Interactions Inter: drugs-CCB's may result in cardiac suppression digoxin may lead to heart block other anti-HTN increase hypertension anti-cholinergic's decreased absorption from the G.I. Labs: increase your tacit lipids potassium creatinine anti-nuclear antibody
Diltiazem/ Cardizem Class: CCB reduced cardiac workload bring more oxygen to myocardium. action: antianginal admin: IV admin continuously monitor cardioversion equipment near extended release should not be crushed or split Preg Cat C
Diltiazem/ Cardizem Side/contradiction Side: Headache dizziness edema of the ankles and feet abrupt withdrawal acute anginal episode con: patient with AV heart block sinus syndrome severe hypotension leading aneurysm undergoing intracranial surgery. Use caution w renal/hepatic impairment
Diltiazem/ Cardizem interaction drugs Inter: other cardiovascular drugs may cause partial or complete heart block heart failure or dysrhythmias ^ digoxin or Quinidine levels additive hypotension w ethanol anti-HTN never use dantrolene cytochrome P – 450 3A4 inhibit metabolism
Diltiazem/ Cardizem interaction food/herbal St. John's wort in ginseng decrease the effectiveness of diltiazem. Garlic Hawthorne in goldenseal may increase the antihypertensive effect
Myocardial infarction (MI) Coronary artery becomes legally occluded deprived of oxygen supply affected area of myocardial become ishemic and myocyte begin to die. Necrosis of myocardial tissue release enzyme markers to diagnose MI
myocardial ischemia Disorder that is usually caused by a critical coronary artery obstruction known as CAD (atherosclerotic coronary artery disease)
Necrosis The death of most or all of the sales in an organ or tissue do to disease, injury, or failure of the blood supply
Pharmacologic treatment of MI Restore bld supply (reperfusion) damage tissue use of thrombolytics or PCI reduce myocardial oxygen to prevent more infarction control or prevent MI dysrhythmias manage severe MI pain prevent enlargement of the thrombus with anti-coagulant/platelet
Thrombolytics (clot buster) Dissolve clots obstructing the coronary arteries and restore perfusion to affected regions of the myocardium
reteplase/ Retavase Class: dissolving blood clots by cleaving plasminogen to form plasma that degrades the fibrin matrix to form thrombi. Admin: reconstitute drug stat prior to use do not shake give through IV do not mix with any other drugs in same IV line Preg Cat C
reteplase/ Retavase side/contraindiction Side: abnormal bleeding prolonged bleeding and injection sites in catheter insertion site dysrhythmias may occur during myocardial reperfusion. Con: patients w active bleeding or history of stroke or recent surgical procedures never combine heparin
reteplase/ Retavase interaction Inter: Drug- aspirin anticoagulants and platelet aggregation inhibitors increase anticoagulant effect and risk of bleeding Herbal/food: ginkgo biloba should be avoided increased risk of bleeding labs: increase serum plasminogen & fibrinogen levels
Created by: bryant-41892